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<meta name="description" content="听课时间：20190804氧化锆用量大，脱粘接的问题。第一部分 氧化锆陶瓷修复体的概述1.氧化锆陶瓷的临床应用用量越来越大，可以做基台遮色，可以用于后牙。也可以用于前牙美学遮色修复。2.成分和加工工艺粉状-瓷块-制作修复体-再次烧结-成本修复体。3.氧化锆是否需要专业粘接系统与医生备牙和患者基牙条件有关。4mm以上牙合龈高度，聚合度合格，可以不用。否则，用吧。4.目前的粘接方法及成效。a.玻璃离子">
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        <p>听课时间：20190804<br>氧化锆用量大，脱粘接的问题。<br>第一部分 氧化锆陶瓷修复体的概述<br>1.氧化锆陶瓷的临床应用<br>用量越来越大，可以做基台遮色，可以用于后牙。也可以用于前牙美学遮色修复。<br>2.成分和加工工艺<br>粉状-瓷块-制作修复体-再次烧结-成本修复体。<br>3.氧化锆是否需要专业粘接系统<br>与医生备牙和患者基牙条件有关。<br>4mm以上牙合龈高度，聚合度合格，可以不用。<br>否则，用吧。<br>4.目前的粘接方法及成效。<br>a.玻璃离子水门汀及双固化树脂水门汀。<br>基牙固位型良好，可以。<br>b.硅涂层技术+水门汀。<br>氧化铝硅涂层，喷砂到氧化锆表面。再用硅烷处理。但硅涂层与氧化锆只是机械嵌合，没有化学粘接。<br>c.氧化铝喷砂+水门汀。<br>用正确的喷砂方式，不会使氧化锆脆化，但没有改变其亲水性。亲水性对粘接不利。<br>d.氧化铝喷砂+氧化锆处理机+水门汀。<br>氧化锆底漆/氧化锆偶联剂，反应5分钟，界面变为疏水性，且可以与水门汀形成化学粘接。<br>e.激光喷砂<br>5.氧化锆陶瓷粘接的临床总结<br>基牙固位型理想，制作紧密，可以不用粘接系统。<br>否则，要使用喷砂+氧化锆底漆+双固化树脂水门汀。<br>第二部分 氧化锆陶瓷界面的处理<br>1.原理<br>物理原理：粗化——喷砂。<br>喷砂强度：2-8Bar<br>喷砂角度：60度（扫）<br>喷砂距离：1-2cm<br>喷砂时间：20s<br>喷砂粒子直径：27-50μm<br>喷砂粉：氧化铝<br>化学原理：MDP与氧化锆能形成化学粘接，MDP-Zr，另一侧能与树脂连接。<br>涂布，反应五分钟，干燥。<br>涂完以后不用再涂粘接剂。<br>2.氧化锆涂底剂的选择<br>a.形成MDP-Zr化学键的量。<br>Bisco的Z-Prime plus最多<br>b.成膜厚度及界面疏水性。<br>牙上要涂粘接剂并固化，否则固化不全会导致脱粘接。<br>越小越好。Biscon Z-Prime plus和Bisco All-Bond Universal(第八代)可以，约10μm。<br>c.是否需要固化（成膜厚度）？<br>Biscon Z-Prime plus没有引发剂等，不用光固化。<br>所以选Biscon Z-Prime plus。<br>3.涂布涂底剂的时机<br>试戴之前涂，修复体没有接触口腔，不会被污染。较理想。<br>4.涂布后界面变化<br>亲水-&gt;疏水，疏水的界面不易被污染。<br>5.涂布涂底剂的界面稳定性<br>用接触角来测量。<br>界面稳定。<br>6.HF硅烷是否可以处理氧化锆。<br>HF反应的主要物质是氧化硅，用HF处理氧化锆无效。硅烷同理，由于没有硅羟基，使用意义不大。<br>7.唾液污染后的氧化锆界面的处理。<br>a.唾液污染的原理<br>唾液里含有磷酸根，可能与氧化锆发生化学反应，消耗锆离子的结合位点，使形成MDP-Zr的数量降低，粘接力下降。<br>b.唾液污染的处理<br>1）试戴前先涂底涂剂。<br>冲洗，清洁。<br>2）试戴前没涂过。<br>不能用磷酸处理。<br>用超声，并不能破坏磷酸根-锆的结合。<br>碱液（义获嘉的Ivoclean），可以。<br>氧化铝喷砂，可以。<br>使用碱液<br>①试戴后无油空气干燥。<br>②涂布Ivoclean20s。<br>③彻底冲洗干净，干燥。<br>④涂布氧化锆涂底剂。<br>喷砂：与氧化锆处理一样的。<br>8.氧化锆界面处理<br>试戴前涂底涂剂，试戴，酒精/超声清洁，粘冠。<br>试戴前未涂底涂剂，试戴，碱液处理/喷砂，清洁，干燥，粘冠。<br>第三部分 预备基牙表面处理<br>1.不同预备体界面的分类<br>a.活髓牙丁香酚氧化锌表面。<br>b.活髓牙IDS表面。<br>c.根管治疗后牙齿表面。<br>d.纤维桩树脂核表面。<br>e.金属桩表面。<br>f.根管治疗漂白后。<br>2.不同预备基牙表面的处理<br>a.活髓牙丁香酚氧化锌表面。<br>游离丁香酚有阻聚作用。如果永久冠在临时修复体之后超过2周就为，大部分游离的丁香酚会消失，能溶于乙醇，丙酮，但不溶于水。<br>残留的丁香酚颗粒是主要的影响因素。<br>处理，喷砂。喷砂时间尽量短，2-5s。其余与修复体处理类似。<br>去除后的牙本质表面未做IDS建议DDS。<br>35%磷酸酸蚀釉质边缘15-30s。<br>强吸吸除水雾冲洗15s。<br>釉质边缘可涂95%酒精。<br>涂布All-Bond Universal 10-15s<br>重复一次。<br>轻吹10至表面发亮光无材料流动<br>固化20-40s。<br>b.活髓牙IDS表面。<br>弱喷砂，时间10s。<br>酸蚀，冲洗，干燥。<br>涂布All-Bond Universal 10-15s<br>重复一次。<br>轻吹10至表面发亮光无材料流动<br>固化20-40s。<br>c.根管治疗后牙齿表面<br>使用全酸蚀，本质15s，釉质30s。<br>吸走，吹干，釉质边缘可涂95%酒精。<br>涂布粘接剂，重复一次。<br>轻吹10至表面发亮光无材料流动<br>固化20-40s。<br>d.纤维桩树脂核表面。<br>喷砂，酸蚀，粘接，光固化。<br>e.金属桩表面。<br>喷砂（10s），仔细清洁，酸蚀牙齿，涂布粘接剂，光固化。<br>f.根管治疗漂白后。<br>建议漂白后2周粘接（封2周氢氧化钙）。<br>氧化铝喷砂树脂充填物5s。<br>酸蚀，粘接。<br>第四部分 水门汀的分类与选择<br>1.水门汀概述<br>要求<br>1）抗溶解性<br>2）通过机械嵌合和化学粘接获得足够的粘接力。<br>3）在拉应力下有高强度，良好的操作特性。<br>4）与被粘接组织有良好的生物相容性。<br>2.分类属性与特点<br>非树脂基水门汀：磷酸水门汀，玻璃离子水门汀。<br>树脂基水门汀：传统树脂水门汀，自粘接树脂水门汀。<br>A1.磷酸水门汀<br>1）常用，缺陷大。<br>硬度低，有溶解性，缺少粘接力，不适合粘接全瓷冠。<br>A2.传统玻璃离子水门汀<br>特点：1）无树脂成分；2）低膨胀系数；3）释放氟术语碳酸类；4）与牙体有一定的化学粘接力。<br>缺点：1）机械强度低；2）无法用于高应力区；3）适合固位好内冠增强型修复体；4）因为是碳酸类无磷酸根与氧化锆无粘接力。<br>A-B, 树脂改良玻璃离子水门汀<br>有树脂成分，属于碳酸类，与氧化锆粘接力低。<br>(3M RelyX Luting)<br>B1,自粘接树脂水门汀<br>含有树脂，磷酸类。有微弱亲水性。<br>B2,树脂水门汀。<br>有树脂成分无粘接成分（碳酸或磷酸）<br>依赖于涂底剂（偶联剂）/粘结剂的粘结。<br>如果牙面锆面需要处理，最好选择树脂水门汀。<br>对于厚度大于1.5mm的亮色调氧化锆颜色和小于0.5mm暗色调氧化锆推荐使用双固化固化材料。<br>(总结：喷砂：物理粘接界面。涂底剂：化学粘接界面。粘结剂成膜厚度&lt;10μm，提前固化。使用双固化水门汀。）<br>实操<br>1.没涂底涂剂，试戴后污染的冠，涂碱液。<br>涂20s。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/01.png"><br>2.冲洗，吹干。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/02.png"><br>3.涂酒精，加强干燥。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/03.png"><br>4.涂ZPP。涂满，涂两遍，轻吹3-5，等5分钟。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/04.png"><br>5.处理基牙。<br>如果活髓牙有丁香酚粘临时冠，等2周。用酒精清洁基牙。<br>吹干。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/05.png"><br>弱喷砂。用楔刀等保护邻牙。<br>喷砂角度右下到上，距离1cm左右，喷2-5s。用水汽冲洗，干燥。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/06.png"><br>6.2%洗必泰处理牙本质，吹干。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/07.png"><br>7.看边缘有无牙釉质。如有，用35%磷酸全酸蚀。15-30s。冲洗，吹干。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/08.png"><br>8.避光，用All-Bond Universal进行自粘接。邻牙放胶带。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/09.png"><br>轻吹，至光亮，无流动性。光固化20-40s。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/10.png"><br>9.修复体吹气干燥60s，不用涂粘接剂。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/11.png"><br>10.用双固化水门汀粘冠，前8mm丢弃，注入到冠内，散匀。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/12.png"><br>11.修复体就位，加压。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/003/13.png"><br>（剩下的步骤跟粘嵌体一样。略了。去除多余粘固剂不要用探针，用刀片等锐器，不然会把修复体与基牙之间水门汀去除。）<br>个人总结：氧化锆的物理粘接就是喷砂，粗化界面。化学粘接是涂底涂剂，原理是涂底剂里的MDP与锆离子形成MDP-Zr。喷砂，酸蚀处理牙面，涂粘接剂，光固化。树脂水门汀粘冠。直接用树脂水门汀或玻璃离子粘冠的，适用于固位型良好的。以前都是试戴清洁后直接粘的。要进一瓶ZPP了。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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